THE URINARY SYSTEM – BLADDER CARE AND MANAGEMENT
The 5 parts of the urinary system work to excrete waste (urine) and keep the chemicals and water in your body balanced. The kidneys are bean-shaped organs about the size of a fist. Urine is made in the kidneys and travels down two thin tubes called Ureters to the bladder. The bladder is a muscular organ shaped like a balloon. The urine is stored in the bladder until it gets full. The sphincter muscles close tightly like a rubber band around the opening of the bladder to help keep urine in the bladder. As the bladder fills with urine, the sensation to urinate becomes stronger. At the point when the bladder reaches its limits, nerves from the bladder send a message to the brain that the bladder is full. To urinate, the brain signals the sphincter muscles to relax. At the same time, the brain signals the bladder muscles to tighten, squeezing urine out of the bladder. When all the signals work normally, the urine exits the bladder through the urethra.
AFTER SPINAL CORD INJURY
After a spinal cord injury (SCI), 3 parts of the urinary system continue to function normally. The kidneys continue to make urine, and urine continues to flow through the ureters and urethra. These functions are involuntary responses, meaning they act without the need for the brain to tell them to. The bladder and sphincter are voluntary muscles that need the brain to coordinate the emptying of the bladder. Such messages are normally sent through nerves near the end of the spinal cord (the sacral level of the spine). However, those messages may no longer travel through the spinal cord after an injury. This means that individuals with SCI may not feel the “urge” to urinate when their bladder is full. They also may not have voluntary control of their bladder and sphincter muscles. The bladder is usually affected in one of two ways:
- Spastic (Reflex) bladder is when your bladder fills with urine and a reflex automatically triggers the bladder to empty. One major problem with a spastic bladder is that an individual does not know when, or if, the bladder will empty
- Flaccid (Non-reflex) bladder is when the reflexes of the bladder muscles are sluggish or absent. If you do not feel when the bladder is full, it can become over-distended, or stretched. The urine can back up through the ureters into the kidneys. Stretching also affects the muscle tone of the bladder.
The sphincter muscles may also be affected after injury. Dyssynergia occurs when the sphincter muscles do not relax when the bladder contracts. The urine cannot flow through the urethra. This results in the urine backing up into the kidneys. This is called “reflux” action. The bladder also may not empty completely. Treatments include medications or surgery to open the sphincter.
BLADDER MANAGEMENT METHODS
Although individuals with SCI may lack the sensation, or “urge” to urinate, the bladder will still need to be emptied. If not, the bladder muscles stretch as the bladder fills, and urine backs up into the ureters and kidneys. This is called Reflux. Reflux damages the bladder, ureters and kidneys. Failure to empty the bladder to relieve pressure can result in serious health problems, even death.
Every individual is different, so it is important that the treating doctor work together with the injured individual to choose a bladder management method that is convenient to empty the bladder. Keep in mind that an effective management program helps to avoid bladder accidents and prevent complications such as infections.
Considerations for designing a bladder management program include the individual’s mobility, finger dexterity, daily lifestyle, loss of normal urinary system function, and their susceptibility to infections. If the individual suffers from a Spastic (Reflex) bladder, the bladder management method will likely be an intermittent catheterization program (ICP), indwelling catheter (Foley or Suprapubic), or a male external condom catheter. ICP is usually the method of choice for individuals to empty a flaccid bladder.
URINARY SYSTEM CARE
An individual with spinal cord injury is at risk for a number of potential urinary system complications. Proper bladder care is the best way to prevent problems and maintain short- and long-term health. Following a self-care checklist is a great way to help prevent potential complications.
Drinking the proper amount of water is one of the most important factors for bladder care. A very important consideration in determining the proper bladder management method is to ascertain how much water the individual typically needs on a daily basis.
Indwelling Catheter – it is recommended that each day the individual drinks about 15 (8oz) glasses of water, which is about 3 quarts.
Condom and Intermittent Catheterization (ICP) – it is recommended that the individual drinks between 8 to 10 (8oz) glasses of liquid per day, which is about 2 quarts. There may be circumstances when drinking more water than recommended is necessary. For example, an individual may need to drink more water if he/she also drinks beverages that contain sugar, caffeine or alcohol. More water is necessary because these drinks cause individuals to urinate more often, which means the body absorbs less water. There may also be circumstances when individuals need to drink less than the recommended amount of water. Less water is necessary if you have another health condition such as congenital heart failure. Of course, individuals should always consult with their doctor if questions arise.
Although a regularly scheduled ICP is preferred, there is really no “recommended” time between intermittent catheterization. If an individual drinks the recommended amounts of water each day, catheterization may only be necessary every 3 or 4 hours. Catheterization will be necessary more often if an individual drinks more liquids or if his/her bladder capacity is less than normal (13-16 ounces). Generally speaking, it is ideal to drink most of the fluids between breakfast (6am) and dinner (6pm). This time frame allows the individual to get his/her daily intake of liquids and empty his/her bladder just before going to bed (10pm). Because your body’s organs usually slow while sleeping, individuals can usually sleep through the night without the need to catheterize before the next morning. If the 6 to 6 time frame does not suit an individual’s lifestyle, adjust the time frame to fit his/her schedule.
Using a “sterile” ICP technique can help individuals stay as germ-free as possible. Sterile ICP kits are one-time use catheters. These ICP kits are also known as “touch free” or “touch less,” which refers to the ability to catheterize oneself without the need to touch the insertion tube. Due to a revised reimbursement policy covering the use of intermittent catheters, most people who have insurance can now get a maximum of 200 intermittent catheters per month instead of the 4 catheters per month under previous policy. The change should allow most users to obtain the closed, sterile ICP kits. Ask your health care provider or contact your insurance provider for more information. Although a closed, sterile system is preferred for ICP, many individuals with SCI still use a “clean” catheterization technique.
STEP BY STEP ICP PROCESS FOR MEN:
Step 1 Assemble all equipment: catheter, lubricant, drainage receptacle (container).
Step 2 Wash your hands thoroughly with soap and water and clean the penis and opening of the urethra.
Step 3 Lubricate the catheter.
Step 4 Hold the penis on the sides, perpendicular to the body.
Step 5 Begin to gently insert and advance the catheter.
Step 6 You will meet resistance when you reach the level of the prostate. Try to relax by deep breathing, and continue to advance the catheter.
Step 7 Once the urine flow starts, continue to advance the catheter another 1 inch. Hold it in place until the urine flow stops and the bladder is empty.
Step 8 Remove the catheter in small steps to make sure the entire bladder empties.
Step 9 Wash the catheter with soap and water. If the catheter is disposable, discard it right away. If it is reusable, rinse the catheter completely and dry the outside. Store the catheter in a clean, dry location.
STEP BY STEP ICP PROCESS FOR WOMEN:
Step 1 Assemble all equipment: catheter, lubricant, drainage receptacle.
Step 2 Wash your hands thoroughly with soap and water and clean the vulva and opening of the urethra.
Step 3 Lubricate the catheter.
Step 4 Locate the urethral opening. The opening is located below the clitoris and above the vagina.
Step 5 Spread the lips of the vagina (labia) with the second and fourth finger, while using the middle finger to feel for the opening.
Step 6 Begin to gently insert the catheter into the opening. Guide it upward as if toward the belly button.
Step 7 Once the catheter has been inserted about 2 – 3 inches past the opening, urine will begin to flow.
Step 8 Once the urine flow starts, continue to advance the catheter another 1 inch and hold it in place until the urine flow stops and the bladder is empty.
Step 9 Withdraw the catheter in small steps to make sure the entire bladder empties.
Step 10 Wash the catheter with soap and water. If the catheter is disposable, discard it right away. If it is reusable, rinse the catheter completely and dry the outside. Store the catheter in a clean, dry, secure location.
Change condom and Foley catheters regularly. Condoms are usually changed daily – every other day at the longest. As for a Foley, there is no real guideline for how often it should be changed, but changes are commonly made monthly.
A Suprapubic catheter is typically inserted by a qualified physician or other health-care provider. A trained professional will also change the suprapubic catheter when needed. The individual should discuss when changes should occur with his/her doctor.
KEEPING PERSONAL URINARY CARE SUPPLIES CLEAN
Before you start, you need a:
- cleaning area such as a sink or wash pan
- strong disinfectant solutions such as liquid bleach or Pine Sol
- small funnel or syringe (not required, but it helps to clean inside the bag, connector & tubing, and
- place to hang leg and bed bag for drying.
STEP BY STEP PROCESS FOR CLEANING URINARY SUPPLIES
Step 1 Unplug the dirty bag, tubing and connector from the catheter.
Step 2 Attach a clean bag, tubing and connector to the catheter.
Step 3 Completely empty urine out of dirty bag.
Step 4 Clamp the drainage valve closed.
Step 5 Use a small funnel or syringe to pour a mixture of water and disinfectant solution through the connector and tubing into the bag (1 part disinfectant to 8 to 10 parts water – less water makes for a stronger disinfectant, but too strong a solution can damage your skin on contact).
Step 6 Shake bag gently so solution cleans all parts of the inside of bag.
Step 7 Open drainage clamp to empty solution from bag.
Step 8 Wash off outside of bag with fresh solution.
Step 9 Repeat steps 4-8 using water without solution.
Step 10 Hang bag up to dry.
Clean your urine drainage bag each day, and check your tubing and connectors every 2 to 3 days for sediment buildup. If you see mineral build up after cleaning, soak the tubing and connector in bacteria-killing solution for 6-8 hours. If this does not remove the buildup, replace the tubing or connector.
Keeping skin clean is another important element for maintaining an individual with SCI’s health. First, always wash hands before and after any bladder management method. To care for the indwelling catheter (Foley or Suprapubic), cleanse the urethral area (where the catheter exits the body) and the catheter itself with soap and water every day. After removing a condom, wash the entire genital area with soap and water before putting on a new condom. Finally, change clothes and wash well immediately after any urine leakage or bowel movements.
Getting a yearly medical check-up should be a part any individual’s long-term care plan. The check-up should include a urologic exam to see that the individual’s urinary system is healthy. This usually includes a renal scan or ultrasound to determine whether or not the kidneys are working properly. The exam may also include an X-ray of the abdomen (KUB). This check-up helps the doctor ensure that the individual’s urinary system is acting appropriately and identify other potential problems as early as possible.
POTENTIAL URINARY COMPLICATIONS
Most complications can be avoided with proper urinary system care. However, individuals with SCI are likely to develop a urinary tract infection (UTI) even with the best bladder care. Not only are individuals with SCI at high risk for UTI, but complications due to UTI are also the #1 medical concern and more likely to affect their overall health and health care costs.
Bacteria are tiny, microscopic single-celled life forms that group together and form colonies. Different bacteria can live in various systems of the body. Those bacteria living in the urinary system can quickly multiply and lead to infection or disease.
Individuals with SCI should watch for early signs of an infection such as sediment (gritty particles) or mucus in the urine; cloudy urine; bad smelling urine (foul odor); and blood in the urine (pink or red urine). Attempt to avoid the onset of an infection by drinking more water; avoiding beverages with sugar, caffeine and alcohol; and emptying the bladder more often.
Antibiotics are used if an individual suffers an infection. Antibiotics are prescribed by a doctor and essentially kill the “bad” bacteria causing the infection. Always follow the doctor’s advice on treatment of UTIs. On the other hand, many doctors do not know that individuals with SCI have special considerations when it comes to the use of antibiotics for UTIs. In order to properly treat an individual with an SCI for urinary complications the treating doctor needs to have experience and familiarity treating those with SCIs. The doctor should know that most (80%) individuals with SCI have bacteria in the urinary system at any given time. The presence of bacteria is common because bacteria from the skin and urethra are easily brought into the bladder with ICP, Foley, and Suprapubic methods of bladder management.
Also, many individuals with SCI are not able to completely empty their bladder, leaving some bacteria in the urine remaining in the bladder. Whereas bacteria identified in a urine culture is commonly cause for treatment by doctors, you do not necessarily need treatment for an infection. Antibiotics are only recommended for treatment of UTIs if you actually develop one or more symptoms of infection that include: fever; chills; nausea; headache; change in muscle spasms; and autonomic dysreflexia (AD). Depending on your level of injury, you may also feel burning while urinating or discomfort in the lower pelvic area, abdomen, or lower back.
When you show symptoms of illness, it is highly recommended that you get immediate advice on treatment from your doctors. Your doctor should also get a urine sample prior to prescribing a treatment. These two actions are recommended so that your doctor can first rule out any other health problems. Second, your doctor can prescribe the most effective antibiotic to treat your specific infection (bacteria type). Finally, antibiotics should be taken exactly as prescribed and for a sufficient duration to fully kill the bacteria.
Use of antibiotics as a preventative measure for UTIs is not recommended unless there is an overriding medical need to prevent an infection. Although there are some circumstances such as pregnancy, when prevention of infection is needed to avoid unwanted medical complications, antibiotic resistance is a major concern for individuals with SCI. Each time you take an antibiotic, the bacteria have the opportunity to change in some way that reduces or eliminates the effectiveness of that antibiotic to kill the bacteria in the future. So it becomes harder and harder to get an effective antibiotic when you actually get sick from a bacterial infection. Whereas bacteria found in the urinary system can cause illness, there are also “good” bacteria found in your digestive system. These bacteria are actually beneficial for maintaining the natural balance of organisms (microflora) in the intestines. Maintaining this proper bacterial balance can help individuals with SCI in their bowel management.
Anytime antibiotics are taken, these medications kill both the good and bad bacteria. Therefore, probiotics are sometimes recommended by doctors during and/or after a course of antibiotics to replenish and restore the numbers of beneficial bacteria lost to antibiotic use. Probiotics are dietary supplements containing potentially beneficial bacteria or yeast. The most common sources for probiotics are yogurt, but other dairy products such as cheese, milk, sour cream and kefir are also probiotics. Although it is likely that a UTI is present when symptoms of illness have been observed, it is possible that the individual may have another health problem. Therefore, it is highly recommended that individuals who show signs of UTI call their doctor immediately for advice on treatment if you develop any symptoms. It is recommended that you provide your doctor with a urine. These two actions are recommended so that the doctor can rule out any other health problems and prescribe the most effective antibiotic to treat the individual’s specific infection (bacteria type).
If an individual becomes ill with two or more UTIs per year, it can be an early sign of other problems with the urinary system. A complete urologic examination may be necessary to find out if a more serious problem is present. Individuals may want to consult with a urologist, a doctor specializing in the treatment of the urinary system.
Remember, any doctor who treats an individual with SCI should be familiar with the medical issues of individuals with SCI. Kidney (Renal) failure was once the leading cause of death for individuals with SCI. Today, improved methods of bladder management have resulted in fewer and less severe complications with the kidneys. A more common cause of death related to the urinary tract is now sepsis (a blood stream infection resulting from a symptomatic infection in the urinary tract). Kidney and bladder stones can form in the urinary system. Such stones usually hinder the kidney/bladder functions and can cause infection. Most individuals with lower levels of injury will notice pain associated with a stone. Those with higher levels are not likely to feel the pain. Blood in the urine is also a common sign that a stone has developed. If an individual experiences reoccurring or prolonged symptoms of AD that seem to be without cause, it may also be a sign of a kidney stone.
Urine leakage or incontinence is a problem for some individuals. Treatment can include both drugs and surgery. Medications are often used to control bladder spasms and tighten the sphincter muscles. Several surgical options are available for treating urine leakage. A new urinary reservoir (“pouch”) is made from bowel tissue. The ureters are implanted into the new bladder “pouch.” The urine is drained with a catheter through an opening (stoma) in either the navel or stomach wall. Another surgical method is bladder augmentation cystoplasty. Here the bladder is enlarged using bowel tissue. Since surgery involves both the urinary and gastrointestinal systems, recovery time is longer.
Bladder cancer is another concern for some individuals with spinal cord injury. Research in aging with SCI shows a small increase in the risk of bladder cancer among individuals with SCI who have been using indwelling catheters for a long period of time. Smoking further increases this risk. If you have used an indwelling catheter for at least 10 years, it is strongly recommended that you have regular cystoscopic evaluations. Treating other problems of the urinary system is important. Many times these problems do not have any symptoms. This means they can go undetected until the problem becomes serious. The annual physical exam and laboratory studies are the best ways to find problems early and treat them before they become serious.
The keys to a healthy urinary system are taking all the proper steps to prevent complications and identifying any complications as early as possible for treatment. This includes learning proper bladder management techniques as well as proper bladder care. Learning these skills will allow an individual to improve the chances for lasting long-term health.
BOWEL MANAGEMENT
THE DIGESTIVE SYSTEM
The digestive system has both upper and lower digestive tracts. The upper digestive tract breaks down the food that you eat into the nutrients that fuel your body. The digestion of waste begins in the lower tract small intestine and large intestine. In a wave-like action called peristalsis, the waste is moved through the large intestine where water is removed, resulting in the left-over stool. A bowel movement (BM) is normally initiated when enough stool collects in the rectum. The urge to empty the bowels intensifies as the rectum fills with stool. When going to the bathroom, the brain then signals the release of the anal sphincter muscle, and muscle action pushes the stool out through the anus. The frequency between each BM normally differs greatly among people. Some people will normally have 1 to 3 movements per day. Normal frequency for some people can be as few as 3 times a week. Normal consistency of the stool can also vary. Although a normal BM should be easy to pass, some people may have harder or softer stools than others.
FOLLOWING SPINAL CORD INJURY
Following spinal cord injury (SCI), messages from the body are not able to reach the brain like before the injury. This usually means a loss of sensation that the bowels are full and the “urge” to empty the bowels is no longer there, and loss of voluntary sphincter muscle control. When normal bowel function is lost due to an injury to the nervous system (spinal nerves), bowel function is commonly referred to as a neurogenic bowel.
In general, two types of neurogenic bowel can occur after SCI. The type depends on the level of injury. A reflex bowel is common with injuries above T-12 (Upper Motor Neuron injuries). With a reflex bowel, the anal sphincter remains closed. However, a reflex BM can still occur at any time and without warning when the stool fills the rectum. With injuries below T-12 (Lower Motor Neuron injuries), there is usually a loss of reflex response, or flaccid bowel. Although there is reduced peristalsis and a loss of anal sphincter tightness with a flaccid bowel, the bowel does not usually empty itself. However, the loose sphincter means mucus and fluid can seep around stool and leak out the anus.
BOWEL PROGRAMS
Stool absolutely must be removed regardless of the level of injury, and thus a bowel program based on the individual’s bowel type will be necessary.
A REFLEX BOWEL PROGRAM may be done daily, every other day, or even as few as 3 times a week. There are 8 general steps in a reflex bowel program:
Step 1 Wash hands thoroughly.
Step 2 Prepare your supplies. You will need:
- gloves (powder and latex free are preferable)
- lubricant (water-based or anesthetic only)
- toilet paper and/or blue under pads (Chux)
- stimulant (Enemeez® mini-enemas or Magic Bullet Suppositories® are generally accepted for regular use by individuals with SCI)
- assistive devices (a suppository inserter, finger extension, and digital stimulator)
Step 3 Get into a comfortable position. When possible, it is best if you sit on a toilet or commode chair so that gravity can help move the stool down and out. If you cannot sit, lay on your bed with your body turned on the left side. Use under pads (Chux). Do not use a bed pan because it may damage your skin.
Step 4 Manual stool removal. The lining of the rectum is delicate. Insert a gloved, lubricated finger into the rectum and gently hook your finger around any reachable stool and remove it from the rectum.
Step 5 Insert a rectal stimulant. Methods for insertion include using a gloved hand to squirt the lubricated mini-enema as high as you can into the rectum. Likewise, place the lubricated suppository high into the rectum, leaving the suppository touching the wall of the rectum.
Step 6 Digital rectal stimulation. Sometimes referred to as “Digi-stim,” this process promotes peristalsis and the relaxation of the sphincter muscle. A good time to begin digital rectal stimulation is once the stimulant starts to act. Mini-enemas will probably start to act within 15 to 20 minutes after the insertion. The suppository will probably start to act within 20 to 30 minutes after insertion. Passing of gas or stool may also indicate a readiness for digital stimulation. Insert a gloved, lubricated finger into the rectum and gently start moving your finger in a circular pattern for 20 to 30 seconds, keeping the finger in contact with the rectal wall. Repeat the process every 5 to10 minutes until the BM is complete.
Step 7 The individual must be able to recognize when the BM is over. Indications that the BM has been completed include determining that there is no more stool after 2 consecutive digital stimulations; mucus coming out without any stool; or if the rectum is closed tightly around the finger.
Step 8 Clean up. Wash and dry the anal area.
A FLACCID BOWEL PROGRAM is usually done one or more times daily. There are 6 general steps in a reflex bowel program:
Step 1 Wash hands thoroughly.
Step 2 Prepare your supplies. You will need:
- Gloves (powder and latex free are preferable)
- Lubricant water-based only)
- Toilet paper
Step 3 Get into position. Most individuals with a flaccid bowel are able to sit on a toilet or commode chair.
Step 4 Manual stool removal. Stimulants are not usually effective for a flaccid bowel, so manual removal of stool is done (as with reflex bowel) about every 5 minutes until the BM is over. Between each 5 minute removal time, you can promote stool movement by utilizing digital rectal stimulation (as with reflex bowel); firmly rubbing your abdomen in a clockwise direction with your hand; and movement of the body. The most commonly utilized body actions are leaning forward and side-to-side; body push-ups to reposition and vary pressure areas; tightening and releasing of abdominal muscles; “bearing down” to force stool out (known as a valsalva maneuver and should be avoided if you have a heart condition); and inhaling air deeply followed by forcing air out by increasing abdominal pressure.
Step 5 Know when the BM is over. The BM is probably over when you have no stool results after 2 manual removals, which is about 10 minutes without results.
Step 6 Clean up. Wash and dry the anal area.
BOWEL MANAGEMENT
Bowel management is essentially the ability to maintain control over bowel movements. Bowel control includes the ability to retrain the bowel to empty at a planned, regularly scheduled time; avoid accidental, unplanned BMs; avoid leakage between each bowel program; maximize stool removal during each bowel program; maintain normal stool consistency; finish each bowel program within a reasonable time (within 60 minutes); feel secure to fully participate in all desired activities of daily living; and keep your body’s digestive system healthy. A properly designed bowel program is only 1 element of bowel management. Other essential elements to a successful bowel management program include:
- Schedule: Before the SCI, an individual’s body was probably trained to have bowel movements that were fairly predictable. For example, you may have had a BM each morning at roughly the same time of day or every other day. Following injury, the individual must essentially retrain the body to respond with a BM only when stimulated during your bowel program. Individuals will need to select a time of day when having a BM best fits your lifestyle. If it is at all possible, individuals should maintain the same schedule that was implemented at the beginning of rehabilitation. Individuals should attempt to follow this schedule until they are accident free between multiple bowel programs. Once your body has adjusted and is well trained to respond with a BM only when stimulated, you may then adjust your bowel program schedule if needed. For example, you may prefer to change your bowel program from morning to night or choose to perform a bowel program every other day instead of every day. Whether you change your schedule or not, you should be able to eventually feel fairly secure in maintaining a regular, predictable bowel program.
- Nutrition: When and what you eat greatly influences your bowel program. For example, eating a meal, high fiber snack, or drinking a warm liquid (such as hot tea, hot apple cider, etc.) initiates peristalsis in a reflex bowel. If you eat or drink something warm about 30 minutes prior to starting your bowel program, you will likely have more effective results. Your fiber intake helps maintain the health of your entire digestive system. Although some individuals take a fiber supplement, vegetables, fruits and whole grain foods are the recommended sources for getting your daily fiber intake. You need about 25 to 35 grams(g) of fiber each day. However, you need to gradually make changes to your fiber intake because sudden increases in fiber intake can cause diarrhea and decreases in fiber intake can cause constipation. Some foods, especially eaten in excess, are more likely than others to cause common bowel problems. For example, dairy products, white potatoes, white bread and bananas can contribute to constipation. Fruits, caffeine and spicy foods can cause diarrhea. Beans, corn, onions, peppers, radishes, cauliflower, sauerkraut, turnips, cucumbers, and apples can cause excessive gas buildup.
- Water: Water should be your beverage of choice for many reasons. A big reason is that water helps regulate your body’s digestive system, keeps your stool from getting too hard, and prevents constipation and impaction. Although fresh vegetables and fruits are good sources for water as well as fiber, you still need to drink the proper amount of water. Generally, your bladder management method will determine how much water you typically need daily.
- Physical Activity: Engaging in physical activity promotes easier passage of food through the digestive system.
- Medications: Many over-the-counter and prescription medications can impact your bowel program. These include bowel-related medications that you take by mouth (orally) or by suppository, and some medications that you take for other reasons can influence your bowel function. Therefore, you should always talk with your health care provider before taking any medication. Constipation and diarrhea are common side-effects of medications. For example, codeine, ditropan, probanthine, and aluminum-based antacids can cause constipation. Magnesium-based antacids can cause diarrhea. Stool softener and laxative use are common among individuals with SCI. Although Colace® (stool softener) and Peri-Colace® (stool softener with added laxative) are mild and may be well tolerated by most people, too much or too little dosage may result in diarrhea or constipation.
- Regularity: Every individual with SCI is unique, but you will likely agree that an unplanned BM is one of the most embarrassing things that can happen. Your best chance to avoid accidents is with consistent bowel management and established bowel program. For example, you should maintain your routine even if your normal routines get interrupted by travel, sickness or the like. If you have an unplanned BM, you still need to continue your bowel program when it is scheduled. Individuals should consult with their doctor when adjustments to the bowel program are necessary.
COLOSTOMY
A colostomy is a surgically-created hole leading from the large intestine to the outside of the abdomen. Typically, a bag is placed over the abdomen hole to collect the stool before it gets to the rectum. Do not necessarily rule out a colostomy on first thought. This procedure is becoming more popular among individuals with SCI, especially people with constant bowel problems. In such cases, a colostomy can greatly improve quality of life. To determine whether a colostomy is a helpful treatment option for a given individual, begin by researching colostomy use and how it works as a bowel program option. If it is an option of interest, attempt to speak with someone with SCI who has one. Then, talk to a physiatrist (doctor in rehabilitation medicine) to discuss whether a colostomy is a good option for the particular individual.
